http://www.drugs.com/monograph/metronidazole-hydrochloride.html#r297 Oral 500 mg twice daily given for 7 days.

297 341 If repeated failure occurs, CDC recommends 2 g once daily given for 5 days.297 341 Others recommend retreatment with 24 g daily for 714 days if metronidazole-resistant strains are involved.153 199 Do not administer repeat courses of treatment unless presence of T. vaginalis is confirmed by wet smear and/or culture and an interval of 46 weeks has passed since the initial course. 152 197 If treatment of resistant infection is guided by in vitro susceptibility testing under aerobic conditions, some clinicians recommend that T. vaginalis strains exhibiting low-level resistance (minimum lethal concentration [MLC] <100 mcg/mL) be treated with 2 g daily for 35 days, those with moderate (intermediate) resistance (MLC 100200 mcg/mL) be treated with 22.5 g daily for 710 days, and those with high-level resistance (MLC >200 mcg/mL) be treated with 33.5 g daily for 14 21 days.124 302 338 340 Because strains with high-level resistance are difficult to treat,124 297 302 338 340 CDC recommends that patients with culture-documented infection who do not respond to repeat regimens at dosages up to 2 g daily for 35 days and in whom the possibility of reinfection has been excluded should be managed in consultation with an expert (available through CDC).

Advice to Patients

Advise patients that antibacterials (including metronidazole) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).152 197 430 Importance of completing full course of therapy, even if feeling better after a few days.152 197 430 Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with metronidazole or other antibacterials in the future.152 197 430 Metronidazole extended-release tablets should be taken at least 1 hour before or 2 hours after meals; optimum absorption occurs under fasting conditions.430 Advise patients to avoid alcohol during and for at least 1 day after conventional tablets152 or at least 3 days after receiving metronidazole capsules or extended-release tablets. 197 430 Advise patients to promptly discontinue metronidazole and contact clinician if abnormal neurologic signs occur.152 197 430 Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs.152 197 430 Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.152 197 430 Importance of advising patients of other important precautionary information.152 197 430 (See Cautions.)

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